Provider Demographics
NPI:1497277016
Name:KENNEDY INDIVIDUALIZED COMMUNITY SERVICES
Entity Type:Organization
Organization Name:KENNEDY INDIVIDUALIZED COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-674-5654
Mailing Address - Street 1:6337 SHAW RD
Mailing Address - Street 2:
Mailing Address - City:MELBER
Mailing Address - State:KY
Mailing Address - Zip Code:42069-8834
Mailing Address - Country:US
Mailing Address - Phone:270-674-5654
Mailing Address - Fax:
Practice Address - Street 1:6337 SHAW RD
Practice Address - Street 2:
Practice Address - City:MELBER
Practice Address - State:KY
Practice Address - Zip Code:42069-8834
Practice Address - Country:US
Practice Address - Phone:270-674-5654
Practice Address - Fax:270-674-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142267235Z00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty